Comparison of cryotherapy to imiquimod 5% in the treatment of anogenital warts

Stefanaki, Christina; Katzouranis, I; Lagogianni, Eirini; Hagjivassiliou, Maria; Nicolaidou, Electra; Παναγιωτόπουλος, Αλέξανδρος; Anyfantakis, V; Bethimoutis, George; Rallis, Eustathios; Antoniou, Christina; Katsambas, Andreas

doi:10.1258/ijsa.2007.007196

Cited by 30 publications

(30 citation statements)

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“…Treatment options further include topical therapies, for example, with salicylic acid, cantharidin, podophyllotoxin, 5-fluorouracil or bleomycin; other immunomodulatory treatments (interferons); physical destruction (surgical excision, cryotherapy, electrodessication or laser therapy) and homoeopathic therapy (19)(20)(21). Cryotherapy causes tissue necrosis and stimulates a specific immune responses (19,20).…”

Section: Discussionmentioning

confidence: 99%

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Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety

Yang

Zhu

Dang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract.Patients with condyloma acuminata (CA) during pregnancy represent a special risk group. The outcomes of many treatment methods for such cases are not satisfactory. The purpose of the present study was to evaluate the treatment outcome and safety of cryotherapy combined with proanthocyanidins (PCs) for CA in pregnant women. In this study, 46 pregnant women with CA were treated with cryotherapy combined with PCs. The lesions were sprayed with liquid nitrogen until the color of the wart changed from flesh colored to purple. A PC-containing formulation was then sprayed onto a non-woven fabric or single-layer gauze and applied to the affected area. The PC treatment was applied for 20 min, 2 or 3 times per day. All patients were followed up at 1 and 3 months. No visible warts remained after the cryotherapy and PC treatment. At the 1-month follow-up, only 1 case of recurrence was identified. At 3 months, 5 cases of recurrence were identified, and the recurrence rate was 10.9%. The satisfaction rate of the patients was 94% at 1 month and 87% at 3 months after treatment. All pregnancies resulted in healthy live births without delivery complications. Cryotherapy combined with PCs is indicated to be a safe and effective procedure and may serve as a treatment option for pregnant women with CA. IntroductionCondyloma acuminata (CA) are symptomatic genital lesions caused by human papilloma virus (HPV). Patients who have CA during pregnancy are a particular risk group. During pregnancy, vaginal secretions contacting the skin and mucous membranes are more abundant (1), meaning that the vulva will remain in a moist and immersed state, which would be problematic for CA patients. Several factors associated with pregnancy can promote the growth of HPV-induced lesions, for example, pregnancy hormones and reduced immunoresponsiveness. Cases of CA in pregnancy are normally characterized by fast-growing warts, and a reduced tolerance and poor compliance to treatment (2).Only a small number of treatments have been tested and recommended in pregnancy; at present, bi-and tri-chloroacetic acid (BCA/TCA), cryotherapy, electrocautery and surgical excision, including laser treatment, are the only recommended treatments. In addition to high recurrence rates, significant side effects have been observed for these methods, including local ulceration and scar formation, which may reduce a patient's compliance with treatment requirements (3). Moreover, medicine could potentially cause fetal malformation and laser treatment and surgical excision may cause uterine contraction, or even abortion (1,4).Cryotherapy is widely used for the treatment of CA. During the cryotherapy procedure, liquid nitrogen freezes the tissue and thereby causes necrosis; the treatment also stimulates specific immune responses, such as an immunomodulatory action of T lymphocytes against the remaining viable wart tissue (5,6). The advantages of cryotherapy are that it is simple, inexpensive, rarely causes scarring or depigmentation, and is safe for use in pregnancy.Pro...

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Section: Discussionmentioning

confidence: 99%

“…Cryotherapy causes tissue necrosis and stimulates a specific immune responses (19,20). As aforementioned, cryotherapy is a simple, inexpensive treatment that rarely causes scarring or depigmentation, and is safe in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety

Yang

Zhu

Dang

et al. 2016

Experimental and Therapeutic Medicine

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“…The licence for imiquimod 5% cream indicates that treatment can be given for up to 16 weeks and recommends an application schedule of three times per week on non-consecutive days. 58 Studies were identified evaluating application of imiquimod 5% for 4, 8, 12 and 16 weeks 130,133 and at application schedules of once daily, twice daily and three times daily. 129,134 After consultation with clinical experts on the potential influence of treatment duration, dose and formulation (relates to ease of application) on clinical effectiveness, the following assumptions were made for the purposes of carrying out meta-analysis, both direct and indirect:…”

Section: Interventions and Comparatorsmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

Thurgar¹,

Barton²,

Karner³

et al. 2016

Health Technol Assess

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BackgroundTypically occurring on the external genitalia, anogenital warts (AGWs) are benign epithelial skin lesions caused by human papillomavirus infection. AGWs are usually painless but can be unsightly and physically uncomfortable, and affected people might experience psychological distress. The evidence base on the clinical effectiveness and cost-effectiveness of treatments for AGWs is limited.ObjectivesTo systematically review the evidence on the clinical effectiveness of medical and surgical treatments for AGWs and to develop an economic model to estimate the cost-effectiveness of the treatments.Data sourcesElectronic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, The Cochrane Library databases and Web of Science) were searched from inception (or January 2000 for Web of Science) to September 2014. Bibliographies of relevant systematic reviews were hand-searched to identify potentially relevant studies. The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for ongoing and planned studies.Review methodsA systematic review of the clinical effectiveness literature was carried out according to standard methods and a mixed-treatment comparison (MTC) undertaken. The model implemented for each outcome was that with the lowest deviance information criterion. A de novo economic model was developed to assess cost-effectiveness from the perspective of the UK NHS. The model structure was informed through a systematic review of the economic literature and in consultation with clinical experts. Effectiveness data were obtained from the MTC. Costs were obtained from the literature and standard UK sources.ResultsOf 4232 titles and abstracts screened for inclusion in the review of clinical effectiveness, 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by MTC indicated that ablative techniques were typically more effective than topical interventions at completely clearing AGWs at the end of treatment. Podophyllotoxin 0.5% solution (Condyline®, Takeda Pharmaceutical Company Ltd; Warticon®solution, Stiefel Laboratories Ltd) was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. In total, 84 treatment strategies were assessed using the economic model. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if AGWs did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000–30,000 per additional quality-adjusted life-year gained. The result was robust to most sensitivity analyses conducted.LimitationsLimited reporting in identified studies of baseline characteristics for the enrolled population generates uncertainty around the comparability of the study populations and therefore the generalisability of the results to clinical practice. Subgroup analyses were planned based on type, number and size of AGWs, all of which are factors thought to influence treatment effect. Lack of data on clinical effectiveness based on these characteristics precluded analysis of the differential effects of treatments in the subgroups of interest. Despite identification of 60 studies, most comparisons in the MTC are informed by only one RCT. Additionally, lack of head-to-head RCTs comparing key treatments, together with minimal reporting of results in some studies, precluded comprehensive analysis of all treatments for AGWs.ConclusionsThe results generated by the MTC are in agreement with consensus opinion that ablative techniques are clinically more effective at completely clearing AGWs after treatment. However, the evidence base informing the MTC is limited. A head-to-head RCT that evaluates the comparative effectiveness of interventions used in clinical practice would help to discern the potential advantages and disadvantages of the individual treatments. The results of the economic analysis suggest that podophyllotoxin 0.5% solution is likely to represent a cost-effective first-line treatment option. More expensive effective treatments, such as CO2laser therapy or surgery, may represent cost-effective second-line treatment options. No treatment and podophyllin are unlikely to be considered cost-effective treatment options. There is uncertainty around the cost-effectiveness of treatment with imiquimod, trichloroacetic acid and cryotherapy.Study registrationThis study is registered as PROSPERO CRD42013005457.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…An abundant amount of literature is available on the use of cryotherapy for treatment of cutaneous [12] and anogenital warts [9,[13][14][15][16]. Within this small spectrum of reports even fewer studies have been published about cryotherapy use for treatment of oral condyloma acuminatum.…”

Section: Discussionmentioning

confidence: 99%

Oral Multifocal Papillary Lesions in a Young Child: Clinico-Pathologic and Medico-Legal Considerations

Salek¹

2013

J Dent Oral Disord Ther

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Services (CPS) for further investigation and for ensuring child safety [6]. A diagnosis of HPV-positive multifocal oral lesions in a child could potentially represent condyloma acuminatum or Heck's disease since clinical and histopathology findings and the presence of HPV without specific subtyping are not pathognomonic for either disease. We report a unique case of a 12-year-old boy presenting with oral multifocal papillary mucosal lesions that were confirmed positive for HPV by histopathology and in situ hybridization. California CPS was notified as per our clinical protocols for further investigation. Case ReportA 12-year-old Hispanic boy was referred to the Orofacial Pain and Oral Medicine Clinic at the Herman Ostrow School of Dentistry for evaluation of multifocal intraoral lesions. Head and neck examination revealed the presence of multiple asymptomatic, pink to white in color, coalescing lesions of the lower lip, buccal mucosa, and commissures as demonstrated in Figure 1. Some of the lesions appeared sessile, others pedunculated, and others papillary; all had similar and overlapping features. The lesions were not painful and were rubbery soft to palpation. The remainder of the head and neck exam was unremarkable, and a review of systems and medical history were non-contributory. The patient was not taking any medications and the social history was non-contributory. The patient and his mother AbstractHuman papilloma virus (HPV) is a non-enveloped DNA virus that infects cutaneous and mucosal epithelial cells. Oral lesions of HPV can present as solitary or multifocal lesions, and multifocal lesions can represent a diagnostic challenge clinically with important medicolegal considerations in some cases. We report a unique case of a 12-year-old boy presenting with oral multifocal papillary mucosal lesions which upon biopsy was found to be consistent with a diagnosis of condyloma acuminatum or Heck's disease histopathologically; in situ hybridization studies also confirmed positivity for low risk HPV subtypes in affected tissue. Based on the pathology results and our clinical protocols, we contacted social servicesto rule out the sexually transmitted disease condyloma. A final diagnosis of Heck's disease was rendered after clinico-pathologic and social correlation. Cryotherapy with topical anesthesia was used to successfully treat the lesions with no evidence of recurrence on 6 month follow-up.

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Comparison of cryotherapy to imiquimod 5% in the treatment of anogenital warts

Cited by 30 publications

References 20 publications

Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety

Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety

Clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts: systematic review and economic evaluation

Oral Multifocal Papillary Lesions in a Young Child: Clinico-Pathologic and Medico-Legal Considerations

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